Poliomyelitis in Pakistan

Pakistan is one of three countries[1] in the world where poliomyelitis (polio) is still categorized as an endemic viral infection.[2] Though the polio immunization campaign in the country started in 1974, the efforts for eradication officially started only in 1993. About sixty rounds of vaccination have been carried out in the country up til 2007 but the infection is still endemic.[3] Polio cases in Pakistan rose by 37 percent in 2011,[1] though by 2015 only 7 new cases were reported in the Federally Administered Tribal Areas, and only one in Karachi - representing a 70% decline in new cases as compared to 2014.[4] The World Health Organization has reported the presence of the polio virus in Lahore, Rawalpindi and Peshawar, where the virus was found in the sewage systems.[5]

According to a report by Heidi Larson published in The Guardian, polio eradication efforts have been hampered since it was revealed that the US Central Intelligence Agency employed the services of a Pakistani doctor Shakil Afridi and local health officials to stage a fake vaccination campaign in order to collect DNA samples of Osama Bin Laden (to confirm his presence) before Operation Neptune Spear.[6] By 2015, however, new cases of polio had dropped by 70% as compared to 2014, due to increased vaccination in parts of the northwest Pakistan that had previously been under the control of militants opposed to vaccinations.[4]

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In 1991, due to financial constraints, only 83 percent of Pakistani children had been vaccinated.[7] Intensive eradication campaigns such as door-to-door vaccinations only started after 1999. Recognizing the efforts of Rotary International, who contributed about $12 million to the cause, the government of Pakistan issued a postage stamp on the hundredth anniversary of that organization in December 2000.

In March 2001 about 27 million children were vaccinated across the country, in the hope that Pakistan could be virus-free by the end of that year.[8] As of 2004, when there were 30 million children in Pakistan under five, about 200,000 health workers were required for a vaccination campaign that was carried out eight times a year.[9] A documentary, Polio True Stories, was aired on several television channels to make people aware of the problems facing people affected by the disease.[10]

Some of the reasons which affect the eradication of polio are political unrest, poor health infrastructure, and government negligence. The most afflicted areas are those where militants are present and government does not have absolute control; like the Federally Administered Tribal Areas. Transmission of the virus from such areas then leads to spread through other parts of the country.

Due to the fact that the vaccines are primarily produced in western countries, the militant groups like Tehrik-i-Taliban propagandize that they are made out of pig fat or contain alcohol, the two things that are forbidden in Islam. Some clerics have also denounced the vaccines.[11] There is also a myth prevalent in many of the areas with low literacy rates that the immunization sterilizes the local population.[6]

In early 2012, it was reported that some parents refused to get their children vaccinated in Khyber Pakhtunkhwa and FATA on religious grounds but overall religious refusals in the rest of the country have "decreased manifold".[12]

The fake campaign has had terrible and deadly consequences for the country's fight against Polio. Since 2012, more than 66 polio workers have been killed in Pakistan. Many of the attacks have been claimed by Taliban; they claim that the vaccination campaigns are actually a facade for intelligence gathering[15] and that the vaccinators are actually spies. In Pakistan's North Waziristan agency, local Taliban leaders have also issued a fatwa against the vaccinations until the US drone strikes are stopped.[11] The effect further became evident when the world's highest number of polio cases (198)[12][16] were reported in Pakistan in 2011.[17]

In 2015, the Khyber Pakhtunkhwa government issued arrest warrants for 1,200 parents and guardians for refusing to administer vaccine to their children. 512 people were arrested on the charge but were later freed after having signed an undertaking that they would not oppose vaccination.[18]

By 2015, new cases of polio had dropped by 70% as compared to 2014, due to increased vaccination in parts of the northwest Pakistan that had previously been under the control of militants opposed to vaccinations after those areas were secured by Pakistani forces in the Zarb-e-Azb Campgain against Taliban militants.[4]Previously, vaccination teams were forbidden by militants from vaccinating children in the area.